Individual
ERIN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4401 N MAIN ST, ROCKFORD, IL 61103-1277
(815) 921-9200
Mailing address
95 GRANT ST APT 1, CRYSTAL LAKE, IL 60014-4330
(317) 531-1697
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
242.004526
IL
Other
Enumeration date
08/15/2017
Last updated
08/15/2017
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